Most women keep using IUDs, contraceptive implants

More than 90 percent of women who opt for long-term reversible forms of birth control keep using them for at least six months, a new study found.

Those birth control methods include intrauterine devices (IUDs) and contraceptive implants.

The findings mean most women did not have side effects, such as cramping or bleeding, that were serious enough for them to stop using their birth control.

“There is the perception among healthcare providers that women discontinue these methods rapidly,” senior author Dr. Tessa Madden said. She is an assistant professor of obstetrics and gynecology at the Washington University School of Medicine in St. Louis.

IUDs are placed inside the uterus and prevent pregnancy for up to five or 10 years, depending on the brand. The contraceptive implant is inserted under the skin of a woman’s arm and works for three years.

Both methods are 99 percent effective at preventing pregnancy - better than the Pill, the vaginal ring and condoms. But they are used by less than one in ten U.S. women.

The IUD at a Glance
Small, “T-shaped” device inserted into the uterus to prevent pregnancy
Safe, effective, and long lasting
Must be inserted by a health care provider
Costs between $500 and $1,000 up front, but lasts up to 12 years

That is partly because some doctors may assume women will not be happy with these methods, the researchers said.

“We hope that this study helps reassure providers that the discontinuation rate is not a big concern,” Madden said.

Her team’s study included about 6,000 women between the ages of 14 and 45. Women could choose to start using the levonorgestrel-releasing IUD (marketed as Mirena), the copper IUD (ParaGard) or the contraceptive implant (Implanon).

How Does an IUD Work?

Both the copper and hormonal IUDs work mainly by affecting the way sperm move so they can’t join with an egg. If sperm cannot join with an egg, pregnancy cannot happen.

For some women, hormonal IUDs may prevent the egg from leaving the ovary. Pregnancy cannot happen if there is no egg to join with sperm. Progestin also prevents pregnancy by thickening a woman’s cervical mucus. The mucus blocks sperm and keeps it from joining with an egg.

The researchers counseled women about what to expect with their chosen birth control method. Then they kept track of if, when and why women stopped using their birth control through phone calls.

About seven percent of women using levonorgestrel IUDs or implants and eight percent of copper IUD users chose to have their device removed in the first six months. Younger women continued using these methods just as often as older women did, according to findings published in the journal Obstetrics and Gynecology.

“We showed in this analysis that fewer than 10 percent of women discontinue before six months, and that the same is true for teens,” Gina Secura said. An epidemiologist at Washington University in St. Louis, she also worked on the study.

Types of IUDs

Hormonal IUD. The hormonal IUD, such as Mirena, releases levonorgestrel, which is a form of the hormone progestin. The hormonal IUD appears to be slightly more effective at preventing pregnancy than the copper IUD. The hormonal IUD is effective for at least 5 years. Copper IUD. The most commonly used IUD is the copper IUD (such as Paragard). Copper wire is wound around the stem of the T-shaped IUD. The copper IUD can stay in place for at least 10 years and is a highly effective form of contraception.
How it works
Both types of IUD prevent fertilization of the egg by damaging or killing sperm. The IUD also affects the uterine lining (where a fertilized egg would implant and grow).

Hormonal IUD. This IUD prevents fertilization by damaging or killing sperm and making the mucus in the cervix thick and sticky, so sperm can’t get through to the uterus. It also keeps the lining of the uterus (endometrium) from growing very thick. This makes the lining a poor place for a fertilized egg to implant and grow. The hormones in this IUD also reduce menstrual bleeding and cramping.Copper IUD. Copper is toxic to sperm. It makes the uterus and fallopian tubes produce fluid that kills sperm. This fluid contains white blood cells, copper ions, enzymes, and prostaglandins.

That’s important because younger women may stand to benefit most from IUDs or contraceptive implants, Madden told Reuters Health. These women tend to have more pregnancies than older women while using other types of birth control, such as the Pill or the vaginal ring.

“Many providers and clinic staff incorrectly believe that young women will quickly discontinue these (long-acting) methods because of side effects,” Secura told Reuters Health. “Because of this misconception, providers and clinics are reluctant to offer long-acting reversible contraceptive methods to many young women.”

This study is one of several that open the door to making implants and IUDs go-to birth control methods for all women who want them, the researchers said.

“This is a paradigm shift in family planning,” Madden said.

She cited recommendations from the American Congress of Obstetricians and Gynecologists last year to offer implants and IUDs as first-line birth control methods to all women (see Reuters Health story of September 24, 2012 here: reut.rs/Qu4n2t).

“Studies like this will encourage providers to use these methods more,” Madden said, “and to not create additional barriers for women to get the most effective methods.”

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Characteristics Associated With Discontinuation of Long-Acting Reversible Contraception Within the First 6 Months of Use

OBJECTIVE: To measure discontinuation within 6 months among users of the levonorgestrel intrauterine system, copper intrauterine device (IUD), and etonogestrel implant and identify baseline characteristics associated with early discontinuation.

METHODS: This was an analysis of the Contraceptive CHOICE Project, a cohort study of 9,256 participants provided with no-cost contraception and followed with telephone interviews at 3 and 6 months. We used logistic regression to investigate characteristics associated with early discontinuation of the two IUDs and implant and described reasons for discontinuation.

RESULTS: A total of 6,167 participants were eligible for this analysis. Follow-up data were available for 5,928 participants; 5,495 (93%) were using their method at 6 months and 433 (7%) had discontinued. Discontinuation rates were 7.3%, 8.0%, and 6.9% for the levonorgestrel intrauterine system, copper IUD, and implant, respectively. After adjusting for age, race, marital status, low socioeconomic status, and history of sexually transmitted infection, we found that unmarried women were slightly more likely to discontinue compared with married women (adjusted odds ratio [OR] 1.26, 95% confidence interval [CI] 1.01-1.59 and adjusted OR 1.62, 95% CI 1.11-2.37, respectively). No other baseline characteristics, including younger age (14-19 years), were associated with early discontinuation. The most common reason given for discontinuation was cramping among IUD users and irregular or frequent bleeding among implant users.

CONCLUSION: Rates of discontinuation of long-acting reversible contraception at 6 months is low and not increased in adolescents and young women. Intrauterine devices and the implant should be considered as first-line contraceptive options among all women to reduce unintended pregnancy.

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